Active NPI
Earle Peters
- Pharmacist
- Mankato, MN
National Provider Identifier
1124397252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 111614
- Practice address
- 1270 E Madison Ave
Mankato, MN 56001-5228 - Phone
- (507) 388-1315
- Fax
- (507) 388-6369
- NPI assigned
- Dec 19, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 111614 | MN | Primary |
Addresses
Primary practice location
1270 E Madison Ave
Mankato, MN 56001-5228
Mailing address
140 Marion LN
Mankato, MN 56001-4702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111614 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Mankato, MN
- NPI 1972518280
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1124397252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 MARION LN",
"city": "MANKATO",
"state": "MN",
"postal_code": "560014702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1270 E MADISON AVE",
"city": "MANKATO",
"state": "MN",
"postal_code": "560015228",
"telephone_number": "507-388-1315",
"fax_number": "507-388-6369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "EARLE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-19",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "111614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.